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Upper Extremity: JRA

- Wrist:
    - exam: flexed & ulnarly deviated
    - synovectomy:
         - synovectomy is most indicates before joint changes occur;
    - flexion deformity:
         - 30 deg wrist flexion deformity can be treated by serial splinting & casting;
              - wedging cast can also be used to correct the deformity w/caution to avoid subluxation;

- Hand:
    - MP synovitis is more often seen in the seropositive child;
    - fingers extended, swollen, and radially deviated;
    - synovectomy, repositioning of extensor tendon over MP joint, & intrinsic transfer for tightness may be performed.
    - swan neck deformity in children: treat w/ splint;
    - boutonniere deformity;
    - injection of tendon sheaths w/ corticosteroids often improves ROM
    - tendon ruptures are rare in children and, unlike those in adults, can be rx'ed by primary repair rather than tendon transfer.

- Shoulder:
    - shoulder involvement usually occurs in polyarticular JRA (50%) & in systemic form (80%);
    - loss of internal rotation & abduction is common;
    - children w/ systemic JRA are likely to have severe shoulder involvement

Juvenile rheumatoid arthritis.

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